Thank you, Minister Lee. Once again, committee, we’re on page 8-11, active positions, health and social services authorities, information item. Hoping to blaze forward to 8-13. Do we agree? Mrs. Groenewegen.

I truly hope no one touched on this before, but has any further work progressed on bringing the personnel of the Hay River Health Authority into the GNWT workforce? I know there are issues of cost, retention and different things, but one of the opportunities that is lost is the ability to recruit and transfer and move people about in the system which would include Hay River. I just wondered what the status of that was with regard to personnel. Thank you.

Thank you, Mrs. Groenewegen. Minister Lee.

There has not been real direct work on transferring those positions, although we are aware of the possible need or cost implications of doing that. Thank you.

It’s probably been awhile since that situation has been costed or a cost-benefit analysis done of that particular initiative. I would like to ask the Minister if there is any plan during the upcoming fiscal year to look again at the situation in Hay River. Thank you.

That’s all. Thank you.

Thank you. Mr. Hawkins.

Thank you, Mr. Chairman. Under the directorate section, this is responsible for policy, it’s the policy division. An issue I raised in this House had to do with accreditation for massage therapists as a profession and the concern that there is no legislation or formal policy that is to cover that area. I am just wondering what work has been done in their policy shop in order to bring forward amendments to our Health and Social Services Act to address that gap in our system. Thank you.

Thank you, Mr. Hawkins. Ms. Lee.

Thank you, Mr. Chairman. Yes, that issue has been brought up to me as a Regular Member and as a Minister. I understand the merit of that proposal. At the moment the profession as a whole is quite small and the work that would be involved in legislating that profession is much larger. So what the department and myself are considering is bringing a package of legislation that would deal with a number of unregulated professions in the North. Thank you.

If I remember correctly, the Yukon has a quick and easy way to deal with some of these things through their process and I would hope that the department would look at that as a mechanism for option. When can Members, such as myself, be looking for a package to deal with this type of issue? Can we expect something in this budget year or even sooner, in the sense of a couple of weeks or a couple of months, or should we sort of wait by the phone? When do we expect any adjustments to this? Thank you.

There are number of major pieces of legislation before the department that I need to work through. We don’t have as many resources to address legislative changes as we would like, whether in Justice or in the departmental policy team. Also there are some other legislations that I am considering as well. So let me just tell the Member that I will look at regulating the profession of massage therapists and other professions again, and I will communicate to the Member and other Members in the House about where that would fit into the time frame. Thank you.

I will certainly say that this is excellent in the context that that is what I am looking for to get a sense of where it is in the system. As well, at the same time the Minister is

addressing that, can she provide a summary of potential legislative options that the department is considering as initiatives? Perhaps Members like myself and other Members of the House may have some guidance on ones that we feel are important and should have good and due consideration by the department. There may be a focus from our perspective and I would be surprised if someone did not want to offer any advice from a Regular Member’s point of view as to a priority, but it would certainly be good to know what type of legislative initiatives the department is working on or considering. If we could get that type of list, that would be great, from my point of view. Thank you.

Thank you, and Social Programs can help with that too. Ms. Lee.

Thank you, Mr. Chairman. Yes, I will communicate with the Member and the committee on that. The major legislations that I was referring to are ones that have already gone through standing committee. The names escape me right now, but there is some really heavy-duty legislation that has been in the works, either having gone through this standing committee or the previous standing committee as part of that legislative schedule that is what I was referring to. I understand that if I were to consider doing any other legislation, of course, I would be coming to the committee first. Thank you.

Thank you, Ms. Lee. Anything further? Moving on to Mr. Krutko.

Yes, just in regards to the deficit situation that a lot of the health boards were having, one of the areas of contention was the area of financial accountability and making sure that they were processing receivables and accountables at appropriate times. It was an issue having that work done. I am just wondering what improvements are there in regards to that, in light of the deficits we have seen over the years with certain health boards.

Thank you, Mr. Krutko. Minister Lee.

Mr. Chairman, I think that some of the work that has been done with Stanton has been discussed in the House. Mr. Al Woods, as public administrator, went in there with very direct direction to look at what is causing deficit and how do we better control those or what are the weaknesses and strengths that came up on the balance review report. They have been working on agreements, and receivables, and payables and such.

With respect to Beaufort-Delta, I know that they were without a director of finance for a while. They

have someone with background in auditing and finances who has been hired by the authority -- I think the person started about 5 or 6 months ago -- and so they have more capacity there to look at their finances. Thank you.

Mr. Chairman in regards to, as Members know, we have an issue about services and programs, but when you try to pinpoint where the deficit is occurring from and what is the cost driver which is causing these deficits, I think it seems to be like pulling teeth. No one seems to be really pinpointing where the problem is and they sort of throw a buckshot scatter across the board, where they try to name everything from medical travel to late invoices. It seems like it is not really a system that works to actually pinpoint where the forced growth areas are, where the underfunded programs are occurring, where the cost of health care services...I mean, in most cases you can see what your cost drivers are at the front end, by having good accounting so that you can actually pinpoint where that problem is. But in the case of the Beaufort-Delta, we know that you have so many vacancies, but I just can’t get where you end up with 20-some vacancies but yet you are still running a deficit. I think that without that I would just like to know what is this government going to do differently so that we can fix that problem and be able to get a spreadsheet, if we need, on the spot to identify where these cost drivers are so we can say this is what is causing the deficit, this is what is causing the lack of service delivery.

I know that the capacity issue is a problem in the North, but I know we just have a new Collective Agreement, so hopefully we will see an improvement in that area. So by doing these types of things it will hopefully deal with the problems. I would just like to ask the Minister what exactly is the department going to do differently to ensure that we have financial response and accountability from our health boards to be able to stipulate why we are running a deficit and, if so, where is that deficit occurring. Thank you.

Thank you, Mr. Chairman. The Member’s right in that there are a number of reasons that are put forward, there is no magic bullet saying exactly ABC are causing a deficit of XYZ.

Having said that, the Cabinet, the government is working through looking at some of the cost drivers in health care funding under the Refocusing Government Strategic Initiatives Committee, and I believe that they will be making a presentation to Regular Members on the work that we are doing. There are lots of elements in the health care system that are contributing to costs -- our demographics, general health conditions of our people -- and also within our system, out of the

seven health authorities that we have, all of the authorities are doing well financially in terms of balancing their budget or accumulating small to large surplus, except for Stanton and Beaufort-Delta. The two common factors of those authorities and the elements within those operations that are causing cost overruns are doctor services, specialist services, medical travel, many areas where the costs are hard to control because they are demand driven. That is a big area and that is the area that is under review to see how we can better, not control costs, but find efficiencies where we can and where exactly we can improve. That’s the work of program review and there’s a lot of good work being done there. Thank you.

In regards to the program review that the Minister touches on, again the committee, which is made up of Minister and whatnot, it’s a functional element of being able to pinpoint the problem. I will just throw out some numbers here with regard to my riding. I will use 2007-2008. The communities I represent just on charters alone spent $127,000. That’s just three communities. You look at the cost with regard to the total costs to provide services in my communities with regard to population of 1,500 people, there were 25 cases. They spent $1.4 million. These are actually costs you can actually pinpoint and identify where that cost driver is coming from. I think that is the type of information we need to be able to analyze and dictate exactly where those costs are coming from. Again, as part of your retention of the deficit and trying to bring it down, there has to be certain cuts and arrangements made. I am hoping that through those cuts and bringing down that deficit that you are not eroding any services which right now aren’t even there by even making it harder to get programs and services in our communities and ensuring that the programs and services are being delivered and through this policy shop or directive help that you have, ensuring that they are actually providing health care services in light of the deficit situation they are running and making sure that’s our number one priority. It’s how do you get to that argument and make sure you do manage your expenditures, but manage in a way that you are still providing health care services in the communities that’s being affected. Thank you.

The Member is exactly speaking the challenge of delivering health care services. I should point out that having vacancies in some of these authorities, especially the Beaufort-Delta, does not mean they shouldn’t have a deficit. In fact, the authorities will tell you having vacancies may increase their cost of operating because having locums or agency nurses or somebody else coming to field those positions often costs more. So having vacancies doesn’t mean that you have

money holding there not being spent. It’s most often the opposite.

I do agree with Members that we can’t run the health and social services system saying we have to balance the budget at all costs and we aren’t running it that way, but at the same time we know that in order for us to make sure that our people are provided with essential health and social service programs, we need to find efficiencies or system changes wherever necessary to make sure that we maximize the value of our health care dollar, and that’s what we are trying to do under program review. Thank you.